MedicaidPrior AuthMedium impact
20-1015 Stay Current on Transgender Service Request Rules
Health Net·CA · Family Medicine, Internal Medicine, Endocrinology +4 more·Provider News
Effective date
Oct 26, 2020
We identified it
Jun 20, 2026
Summary
Health Net Medi-Cal now requires transgender service requests to be evaluated under both medical necessity for gender dysphoria treatment AND reconstructive surgery criteria. Either finding serves as sufficient basis for approval, with supporting documentation required from qualified healthcare providers.
Action Required
Immediately: Billing team must update prior authorization request procedures for transgender services to include evaluation under both medical necessity for gender dysphoria AND reconstructive surgery criteria. Ensure supporting documentation from qualified providers (primary care, mental health professionals, or surgeons with transgender healthcare experience) is submitted with all requests. Contact Health Net Medi-Cal Provider Services at 1-800-675-6110 for questions within 60 days.